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Acute aortic dissection — SCE Acute Medicine MCQ

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HardAcute Cardiac PresentationsAcute aortic dissectionSCE Acute Medicine

A 55-year-old man with hypertension presents with abrupt tearing interscapular pain and transient left arm weakness. Blood pressure is 196/104 mmHg in the right arm and 168/92 mmHg in the left. ECG shows non-specific ST-T changes and troponin is mildly raised. Chest radiograph shows mediastinal widening. What is the most appropriate investigation?

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Correct answer: E — Urgent CT aortography

Abrupt tearing pain, pulse or blood pressure differential and neurological symptoms suggest aortic dissection, best investigated with urgent CT aortography in a stable patient. Troponin elevation can occur from coronary involvement or demand and should not lead to blind ACS treatment. Lumbar puncture does not address the vascular emergency. The pearl is that dissection can mimic myocardial infarction and stroke simultaneously.

Reference: ESC Aortic Diseases guideline; NICE chest pain pathway